Just out of Hospital. What is PPN ?

I went to see my new internal medicine doctor at Cleveland Clinic last week and he put me in the hospital that day.. he suggested total bowel rest and TPN for a while , but the GI's did not want to do that and so they did a colonoscopy (again) and this time they did some biopsies to see if I have in fact had some ischemia in the tissue from the low blood pressure. The prep was freaking awful. i had a fecaloma and the pain was so awful..cramps .. I was screaming at the top of my lungs (like Adam on American Idol) and they were wiling to give me morphine but warned that it would slow the colon from getting it out. So i am out and 6 pounds lighter.. The hospital nutritionist had suggested to the doc PPN if solid foods were still causing problem.. what is that? She is worried that if I had to go through a surgery, elective or emergency (like in a case of endoscopy gone bad) then I would likely not make it being so emaciated.. Docs said, no TPN because if I dont use my gut it will atrophy.. I agree with the doc who said let it rest.. You dont walk on a broken leg or it won't heal..

I have been surviving on elemental formula Peptamen 1.5 for a year at $260 aq week out of pocket because my ins wont pay unless it is through a NG or G tube.. I am now broke, so I cant afford it anymore .. do you think they will do something for me when I am anemic and half way in the grave?

Sorry, ranting.. Go Help Us since we rely on these closed minded docs

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Doug,
I'm not really sure on the difference between TPN and PPN other than possibly it is adminstered differently? Just my guess...I don't know.
After having recently had to fight the battle with insurance to get them to pay for TPN, I can relate to your problem getting them to pay for your medicine.
If the internal medicine doctor thought TPN was appropriate..couldn't he have ordered it? I just wondered...my PCP is the one who ordered it for me...I was very fortunate that he was willing to fight the insurance battle for me with the help of the hospital social worker, nutritionist and the people from the pharmacy that would be supplying my TPN. It was a battle as I have mentioned before but it was done. I haven't seen a GI since January, so they haven't had any part in my being placed on TPN. My PCP did say today that he wants me to see the GI again and is setting up an appt. but...he wasn't involved at all up to this point. SO, I was just wondering why the internal guy couldn't have done it for you. I wish you could get on it, it has made a world of difference in how I feel...I still have nausea and vomiting, but I have so much more energy.
I hope that you can get someone to help you soon.
Judy

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Judy, It's always a pleasure to read your replies.. I am so glad you are feeling better, and it sounds like you have finally gotten where you need to be for this time.. I hope that the proper nutritional support will eventually give your body back everything that was taken away.

My primary doc said that the GI has to be the one to make the call on the TPN.. However he said he would write me a prescription for it and I could shop around to see if anyone would do it.. Isn't that insane ?

I guess it's my battle and I have to fight it on my own..

Doug

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Doug,

The difference between TPN and PPN is that TPN is administered through a central line such as a metaport or PICC while PPN is administered through an IV into your regular veins such as a mid-line catheter. Also, PPN is a little diluted from the normal TPN so that it can go through the veins in your arm rather than a vein in your neck.

I'm on TPN but when I had my last port infection in February, the doctor was going to be on vacation for 3 weeks which I can't go that long without TPN so they put in a mid-line catheter into my arm and ordered PPN until he returned to put in a new port. However, since I have had so many cutdowns with my veins at birth, the catheter lasted only 1 hour into my first infusion with it before it blew.

So as for comparing which is better, TPN or PPN, I can't offer any insight into that since I have only had PPN for 1 hour vs TPN since December 2007.

Rickey

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Doug:

PPN is delivered via a regular peripheral line (an IV in the arm, hand, wherever). The dextrose is less in PPN than in TPN. You can still get adequate nutrition, though TPN is better. When I was just in the hospital for 2 weeks with a hickman infection, I was on PPN because they could not use the hickman and did not want a PICC line in next to the infected hickman. It is quite caustic to the veins and if you have awful veins like I do, then you will probably need new IV's daily (like I did - I went through two per day). But at least it kept me stable. Bowel rest can be good, but not for long if you can tolerate tube feeds or food. Have they considered a feeding tube? I have been on TPN so many times and have had many infections with it - I almost died a couple of times. So it's not something that doctors are quick to order, though PPN is a little safer. Good luck - I hope you get the answers you need! It's certainly not good that you lost 6 pounds while in the hospital!

Mimi

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PPN is a very short term solution to the problem. Most clinicians will shy away from it, especially at home, because of the risk of blowing a vein mid feed (I think you will be hard pressed to find a homecare company who will do PPN). Tube feedings are a much more viable option with less risk of infection. It does involve the use of the bowel, though and if you need true bowel rest, this will not be good. Advantages of PPN over TPN include less blood sugar fluctuation and there a host of disadvantages. I had TPN through a PICC line for a few months last year in hopes of gaining weight but to no avail. The doc wanted the line out as soon as I was nutritionally stable because of infection risk.

Try a PEG tube...works for me

Teresa

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